title: A systematic review of rivaroxaban versus enoxaparin in the prevention of venous thromboembolism after hip or knee replacement.
abstract: BACKGROUND
  Rivaroxaban is a novel Xa inhibitor with an encouraging anti-thrombosis effect. The aim of this study is to assess whether rivaroxaban is superior to enoxaparin in venous thromboembolism prevention after knee- or hip-joint replacement.
  
  
  METHODS
  We searched for reports of randomized controlled trials on rivaroxaban versus enoxaparin in venous thromboembolism prophylaxis after knee- or hip-joint replacement in the Cochrane library, Embase, Pubmed, the Ovid database, and Chinese databases including VIP, CNKI, and CBM. Correlated data was extracted and analyzed.
  
  
  RESULTS
  Eight studies involving 15246 patients were included, and all were randomized controlled studies. The methodological quality of six of the trials was generally moderate, while that of the remaining two was considered high quality. 10mg rivaroxaban daily is more effective than 40 mg/30 mg enoxaparin daily after the joint replacement in respect of the incidence of venous thromboembolism (P < 0.0001, RR = 0.38; P = 0.05, RR = 0.77, respectively). No significant difference between 10mg rivaroxaban daily and 40 mg/30 mg enoxaparin daily were found in major postoperative bleeding (P = 0.45, RR = 1.31;P = 0.34, RR = 1.61, respectively). With respect to other outcomes, rivaroxaban is not inferior to enoxaparin, while extended therapy with rivaroxaban (>30 d) is more effective than short-term therapy (<15 d) in relation to the incidence of venous thromboembolism (1.36% versus 10.13%).
  
  
  CONCLUSIONS
  Rivaroxaban is superior to enoxaparin in venous thromboembolism prophylaxis after hip- or knee-joint replacement. Extended therapy--longer than 30 d--is recommended.
authors.affiliation: West China Hospital/West China medical school, Sichuan University, Chendu, China.
authors.forename: Song
authors.initials: S
authors.lastname: Turun
authors.forename: Liao
authors.initials: L
authors.lastname: Banghua
authors.forename: Yin
authors.initials: Y
authors.lastname: Yuan
authors.forename: Li
authors.initials: L
authors.lastname: Zhenhui
authors.forename: Nie
authors.initials: N
authors.lastname: Ying
authors.forename: Chen
authors.initials: C
authors.lastname: Jin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D017984:Enoxaparin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D000069552:Rivaroxaban; D013876:Thiophenes / Q000008:administration & dosage / Q000627:therapeutic use*; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D017984:Enoxaparin; D009025:Morpholines; D013876:Thiophenes; D000069552:Rivaroxaban